The impact of COVID-19 on lung cancer referrals in 2020

In England and Wales, urgent suspected lung cancer referrals were 35% lower between March 2020 and October 2020, compared to the same period in 2019.

There could be reasons which have caused this drop in referral rates, such as:

• changes in patient behaviour in response to the pandemic, such as fear of visiting a healthcare professional
• fewer COPD exacerbations
• change in GP interactions due to virtual consultations or even loss of non-verbal cues
• fewer chest X-rays taking place
• overlap between COVID-19 and lung cancer symptoms.

Lung cancer or COVID-19?

Symptoms of lung cancer and COVID-19 are very similar (see table below). Emerging evidence suggests post-acute COVID-19 may also present further diagnostic challenges in addition
to the acute infection. It is vital to be alert to the risk of lung cancer in patients with persistent and unexplained symptoms. Clear safety-netting advice should be given to patients with a suspected COVID-19 infection, advising them that they are
reassessed if symptoms persist.

The following document, produced by the Lung Cancer Clinical Expert Group, explores the similarities in symptoms in further detail: Differentiation of the Cs in lung cancer: Cancer vs COVID

If COVID-19 is suspected, the patient should be managed according to the latest national guidelines.

Patients with a COVID-19 infection should not be offered a chest X-ray on this pathway. However, safety netting should be in place to reassess and consider whether further investigations are needed, particularly those at risk of lung cancer (smokers,
ex-smokers, family history of lung cancer, exposure to asbestos).

It is important that patients are reminded to see their GP during a pandemic, especially because safety precautions are in place in both primary and secondary care, when attending consultations or follow-up investigations and referrals.

GatewayC Live hosted a Lung Cancer vs COVID-19 webinar. Dr Sarah Taylor discussed some of the key issues around lung cancer referrals and diagnosis during the COVID-19 pandemic with Dr Matt Evison, Consultant in Respiratory Medicine, and Dr Seamus
Grundy, Consultant Respiratory Physician. While we do encourage you to watch the webinar, we do recommend that you finish this course first.

Additional resources

Link: Recognition and referral of suspected lung cancer in the UK during COVID-19 pandemic, Cancer Research UK (2021)
Link: Management of post-acute covid-19 in primary care, The BMJ (2020)
Link: Differentiation of the Cs in lung cancer: Cancer vs COVID, Lung Cancer Clinical Expert Group (2020)
Link: COVID-19 Information for Thoracic Oncology Healthcare Professionals, British Thoracic Oncology Group (2020)
Link: How to differentiate lung cancer from COVID-19 infographic, Lung Cancer Clinical Expert Group and Roy Castle Lung Foundation (2020)